Vendor Selection Criteria

Choosing an electronic medical record (EMR) vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a paper-based system could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.[1]

Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. [2]

Decide what paths and vendors you need to obtain your EHR

Create a checklist with functionalities that your selected EHR must have, is good to have, and must avoid.

Conduct wide screen to map EHRs that meet all or most of your anticipated functionalities and rank them from high to low.

Request advice from organizations that you know or have collaboration about the process of acquiring and implementing EHRs or find potential organizations that you can collaborate with. [7]

Contact or work with your local Health IT offices and regional extension centers for further information and advice.

Check out possible vendors through current users

Find EHR using organizations in your local area or collaborators for their experience and comments.

Ask questions related to EHRs’ core functionality and relevant information, including but not limited to timeline, cost, impact on interruption of productivity, vendor additional charges or hidden charges, evaluation about return on investment, feedback from clinicians, staff, or other users. [7]

Interview certified EHR vendors

Set up phone interview for asking questions as suggested by HRSA website. [7] For example, type of organization (for-profit or not-for-profit), history or duration in EHR business, other users in local area, costs for different phases and upgrades, and supports.

Arrange for vendor demonstrations

Select 2-3 best candidates from previous selection for onsite demonstrations.

Set up an environment that can mimic a real situation for using selected EHRs in your organization that can test how well each EHR can meet the needs of your organization.

Test each EHR if it can integrate with other providers or data systems such as public health interface, billing system, drug post market surveillance, CDSSs, and CPOE.

EMR Selection Tips From A CCRC

Retirement community service providers are generally not considered a priority when the government is considering the purchasing and use of electronic medical record (EMR) systems. While acknowledging the benefits that a new EMR system can bring to their facility, the Jewish Association on Aging (JAA) would like to point out four main challenges it faced with the implementation of the government mandated EMR.
But first they mentioned the positive: the benefits. These benefits included improved reliability of data, improved workflow, and increased quality of life (QOL) for their residents. The JAA is a non-profit continuing care retirement community (CCRC). The impact of the required, updated EMR systems can pose a greater threat to the existence of these non-profit, smaller patient care entities.
This facility would like to share four main challenges which it encounters while trying to update to the new government regulations for EMR regulations.

The first of these challenges was the large burden of financial funding. In order for the JAA to overcome this they first informed their board of directors about what the upcoming mandated changes encompassed, and they stressed the positive benefits of the new EMR implementation. With the support of their board of directors, and grants from local foundations, they were able to meet the first challenge.

The second challenge was to ensure adequate information technology (IT) support for their project. In order to do this, the JAA hired an IT project manager and an EMR nurse clinician to help develop their specific EMR infrastructure.

The JAA realized they had to upgrade the CCRC's hardware and networking system. This was the third challenge they faced in order to implement the demands of a new EMR system.

The fourth challenge was actually selecting the appropriate system to meet their specific needs as a CCRC. In order to do this, the JAA utilized an EMR selection tool by the Leading Age Center for Aging Services Technologies (CAST). This was reported as a major influence in helping them select the appropriate EMR system to meet their specific needs. They also contracted an outside consulting company to aid in the selection process.

Once the JAA had narrowed their choices down to two possible software candidates, they used a five year total cost of ownership (TCO) to make their final decision. The consulting company was able to present a comprehensive image of what the TCO would entail. With this process, the JAA was able to choose the HealthMEDX EMR system. They found HealthMEDX to have evidence of a proven and successful implementation record for their EMR system.[9]

Personal Health Records

Personal Health Records is a vendor selection criteria important for patients in order to have access to personal information through (EHR). (PHR) is an electronic system designed and integrated into the EHR system for patients to maintain and manage their own health information.

PHR will improve health care cost

PHR will improve quality and efficiency

With standalone PHRs, patients fill in the information from their own records and memories, and the information is stored on patients' computers or the Internet.

Tethered or connected PHRs are linked to a specific health care organization's EHR system or to a health plan's information system. The patient accesses the information through a secure portal and for instance will able to track their lab results from the past years. [11]

According to Phillips, et al (2015 ) Strategic Suggestions for PHR are to fully integrate EHR and PHR and "improve patient and population health". [12]

A shared primary care health IT center will be necessary for control, privacy and security.

IT and technical requirements

Usability

Previous studies demonstrated how usability measurements can be applied to the evaluation of EHR systems; however, most of these studies were conducted post implementation. If significant problems have been discovered with usability, at this point in the system development
life cycle it is usually too late to make any major modifications to the EHR system. Therefore, it is important to consider the usability criteria in early stages of the EHR implementation, and particularly during the process of vendor and product selection. [13]

Certification and meaningful use

Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. One must be able to confirm whether an EHR system is HIE certified or not.[14] In addition, meaningful use should be assessed.[15]

Why need vendor certification

certification assures certain level of quality of EHR.

provides sustainability and support by vendor.

CCHIT [16]-Certification Commission for Healthcare Information Technology is one of the well known certification process in the market now.

Vendor assessment

Vendors that develop their own software organically on a single source code, one database, single instance.

Vendors that may operate under one name, but offer several acquired products, including some custom programs.

Vendors that have been acquired/sold/merged as a means to stay more competitive.

The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.[17] However, selection of a vendor also depends on the size of the organization, and the list of services they need. A larger health care organization might need more services, hence the vendor they select must offer multiple products.

Goals

The setting of goals is a critical component of the assessment of EHRs. It is suggested that the goals should be according to the following format

Specific – Achieving the goal would make a difference for our patients and our organization.

Measurable – We can quantify the current level and the target goal.

Attainable – Although the goal may be a stretch, we can achieve it.

Relevant – The goal is worth the effort.

Time bound – There are deadlines and opportunities to celebrate success

Vendor assessment plan

When vendors have been short listed, the following type of analysis should be included in the assessment process. Each vendor should be assessed in a structured process with a ranking of 1-7 for each vendor and criteria:

Functionality Analysis - clinical criteria, workflow processes and outcomes functionality are some of the features that could be the focus

CPR attributes assessment - the vendor's claims of their product's ability to fulfill the computer based patient record attributes and sub-attributes could cross-references and used to contractually bind the vendor to deliver the actual functionality

Technology assessment - stakeholders from the IT architecture department should rank the vendor and product against their list of technical criteria

Cost of ownership - while it may to difficult to assess across vendors for this, initial cost can be divided into capital and operating cost to make this more possible

vendor comparison analysis - structure cross vendor comparison analysis should be conducted by the decision team

Risk Analysis - the specific risk should be objectively analyzed

The selection team should assess the vendors with ranking against the various criteria as this ensures the team focus on objective analysis of each of the vendors.[19]